Impact of the acuity circle model for liver allocation on multivisceral transplant candidates

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Impact of the acuity circle model for liver allocation on multivisceral transplant candidates

Ivanics, Tommy (author): Uppsala universitet,Gastrointestinalkirurgi,Division of Transplant and Hepatobiliary Surgery Henry Ford Hospital Michigan USA.

Vianna, Rodrigo (author): Division of Liver/GI Transplant Department of Surgery Miami Transplant InstituteJackson Memorial Hospital/University of Miami Miami Florida USA

Kubal, Chandrashekhar A. (author): Division of Abdominal Transplant Surgery Department of Surgery Indiana University School of Medicine Indianapolis Indiana USA

Iyer, Kishore R. (author): Recanati‐Miller Transplantation InstituteMount Sinai Hospital New York New York USA

Mazariegos, George V. (author): Hillman Center for Pediatric TransplantationUPMC Children’s Hospital of Pittsburgh Pittsburgh Pennsylvania USA

Matsumoto, Cal S. (author): Medstar Georgetown University HospitalMedstar Georgetown Transplant Institute Washington DC USA

Mangus, Richard (author): Division of Abdominal Transplant Surgery Department of Surgery Indiana University School of Medicine Indianapolis Indiana USA

Beduschi, Thiago (author): Division of Transplantation and Hepatobiliary Surgery Department of Surgery University of Florida Gainesville Florida USA

Abouljoud, Marwan (author): Division of Transplant and Hepatobiliary Surgery Henry Ford Hospital Michigan USA

Fridell, Jonathan A. (author): Division of Abdominal Transplant Surgery Department of Surgery Indiana University School of Medicine Indianapolis Indiana USA

Nagai, Shunji (author): Division of Transplant and Hepatobiliary Surgery Henry Ford Hospital Michigan USA

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(creator_code:org_t)

John Wiley & Sons, 2022
2022
English.
In: American Journal of Transplantation. - : John Wiley & Sons. - 1600-6135 .- 1600-6143. ; 22:2, s. 464-473

Related links:: https://urn.kb.se/re...; show more...; https://doi.org/10.1...; show less...

Journal article (peer-reviewed)

Abstract Subject headings

Liver allocation was updated on February 4, 2020, replacing a Donor Service Area (DSA) with acuity circles (AC). The impact on waitlist outcomes for patients listed for combined liver-intestine transplantation (multivisceral transplantation [MVT]) remains unknown. The Organ Procurement and Transplantation Network/United Network for Organ Sharing database was used to identify all candidates listed for both liver and intestine between January 1, 2018 and March 5, 2021. Two eras were defined: pre-AC (2018–2020) and post-AC (2020–2021). Outcomes included 90-day waitlist mortality and transplant probability. A total of 127 adult and 104 pediatric MVT listings were identified. In adults, the 90-day waitlist mortality was not statistically significantly different, but transplant probability was lower post-AC. After risk-adjustment, post-AC was associated with a higher albeit not statistically significantly different mortality hazard (sub-distribution hazard ratio[sHR]: 8.45, 95% CI: 0.96–74.05; p = .054), but a significantly lower transplant probability (sHR: 0.33, 95% CI: 0.15–0.75; p = .008). For pediatric patients, waitlist mortality and transplant probability were similar between eras. The proportion of patients who underwent transplant with exception points was lower post-AC both in adult (44% to 9%; p = .04) and pediatric recipients (65% to 15%; p = .002). A lower transplant probability observed in adults listed for MVT may ultimately result in increased waitlist mortality. Efforts should be taken to ensure equitable organ allocation in this vulnerable patient population.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)

Keyword

clinical research
practice
health services and outcomes research
intestine
multivisceral transplantation
liver transplantation
hepatology
organ allocation
organ procurement and allocation
organ procurement and transplantation network (OPTN)
registry
registry analysis
united network for organ sharing (UNOS)

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ref (subject category)
art (subject category)

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By the author/editor: Ivanics, Tommy; Vianna, Rodrigo; Kubal, Chandrash ...; Iyer, Kishore R.; Mazariegos, Geor ...; Matsumoto, Cal S ...; show more...; Mangus, Richard; Beduschi, Thiago; Abouljoud, Marwa ...; Fridell, Jonatha ...; Nagai, Shunji; show less...

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Surgery

Articles in the publication: American Journal ...

By the university: Uppsala University

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